Back story: When Whatsit Jr. was 1 month old, he came down with a severe cold that turned out to be RSV. On the scariest night of my life, we were instructed by a hotline nurse at our pediatrician’s office to take him to the ER at Children’s Hospital, where he was promptly admitted, and where that night he was placed on a ventilator to help him breathe. The RSV led to a bacterial pneumonia; the bacteria in question was MRSA, aka methicillin-resistant staph. He was hospitalized for three weeks and on vancomycin, a very powerful antibiotic, for a total of six weeks. It sucked major.
Okay, fast forward to the present. Whatsit Jr. is now a robust almost-4-year-old. He started coughing about a month and a half ago, and the coughing got progressively worse and then leveled off, getting neither worse nor better. After about 3-4 weeks of this, I took him to the doctor’s office. She diagnosed him with bronchitis and prescribed him antibiotics. She said that after the 10-day course, if he was still hacking and coughing, she wanted him to get a chest X-ray, due to his prior history.
So today we had a chest X-ray done, because yesterday was day 10 of meds and he’s still got a wet hack. They just called with the results; apparently Whatsit Jr. has something called “Reactive Airway Disease.” The nurse told me that it’s something they see in kids who are coughing a lot, so the next step is to find out why he’s coughing. We go in tomorrow morning for an appointment so the doctor can check him out in person and see if he needs more antibiotics, or steroids, or an inhaler, or what. The word “asthma” was mentioned but it doesn’t seem to be quite the same as RAD.
I am not asking for medical advice here, as Whatsit Jr. is already under the care of very competent doctors. I am just wondering if anyone else has experience with this disease and can tell me a little more about it. Google has proven less than helpful. Thanks in advance.
Children haqve small airways. Babies routinely get colds within the first couple months which are harmless and sound AWFUL – a small airway gets congested easily. Little kids are also prone to brochiolotis (such as with RSV), croup, allergies, bronchitis and pneumonia, etc.
Some of these babies come from families with a history of asthma or allergies. Some of these children will be diagnosed with asthma as adults. But it is hard to make a diagnosis of asthma before the age of six – they may not use puffers well, and it is tough to do accurate pulmonary function tests on wee 'uns without specialized equipment.
“Reactive airway disease” is sort of a catch all term. It might turn out to be asthma (if still there and tested so after six years of age) or just a propensity for infections and allergies.
Oh, that brings back bad memories. My son, who is now 18, came down with walking pneumonia when he was about 20 months old - he has a fever that would spike, we would give him Children’s Tylenol as per the resident’s instrutions - I was in medical school at the time, some serious flu was running through the emergency rooms of Houston and the resident really didn’t want to see me and my child in the E.R. I brought him in anyway because I was exhausted and panicky and fortunately one of the pediatric professors recognized me, listened to Paul’s lungs, diagnosed him and immediately put him on antibiotics. The fever finally broke and stayed down, the pneumonia cleared up but then he caught a regular cold and began coughing. Persistent, deep, hacking, from the chest until he would vomit, and OTC remedies wouldn’t touch it. He would cough in his sleep. The cold went away and he would stop coughing, but the most minute amount of nasal drainage would bring back the full blown coughing, projectile vomiting and all. His pediatrician diagnosed the reactive airway syndrome on the second visit and prescribed liquid Proventil, which he lived on with every cold until he was about 4. It seemed to gradually get less and less severe. I vaguely remember the doctor saying it was like a precursor to asthma but not as severe - he was never on an inhaler
I had never heard of Reactive Airway Disease And I thought I knew all the major medical stuff…huh. I need to get myself a PDR again.), but your description of your childs cough and how it stays the same pretty much sounds like the allergy cough that my daughter ( and I, now) suffer every fall.
How long ago did it start happening? See if you can backtrace to when it started and you just might find it was at the time when the evil ragweed season was hitting us mere mortals.
What’s worked for us has been singulair (at night), Advair (once a day) and claritin ( in the am) combo. YMMV
They told us a few weeks ago that my son has this.
We picked up a nebulizer machine and after a week or so worth of breathing treatments 2-3 times a day he is all fixed up for now.
Too soon to say much else about future flare ups or anything but you may wind up with one of these whiz bang berating treatment machines of your own soon.
My son has Reactive Airway Disease and ends up on a neubulizer (spelling?) periodically. Basically, he can’t shake the cough that comes with a cold, and gets wheezy. The cough must be wet and wheezy and improve with albuterol treatment to qualify as a, RAD episode.
What we were told is that if he gets more than a certain # of episodes per year (can’t remember the number) he gets re-classified as asthmatic. At that point he may go on maintence albuterol/steroids and qualify for the flu vaccine during periods of shortages.
He has not had more than 1 or 2 a year for the past three years. He is now almost 11.
Thanks for the info so far, guys, especially Dr_Paprika. I’m feeling a little better about the whole thing, as it sounds eminently manageable, wherever on the scale Whatsit Jr. happens to fall. More comments, stories, anecdotes welcome, of course.
MsWhatsit, did they do a culture for pertussis? Actually, on re-reading your post, it would be too late anyway. Is he immunized?
Whooping cough is on the rise, but is very often mis-diagnosed.
Dr_Paprika said everything about RAD I would say.
When he had RSV, do you remember if he was treated with Ribavirin? I’ve read one research paper linking Ribavirin treatment in infancy with later respiratory weakness.
Picunurse brings up an excellent point. It might be worth doing a culture for pertussis (whooping cough). Unfortunately, even though erythromycin (or other macrolide) will kill the Bordatella bacteria, the “hundred day cough” is due to exotoxins still there after the bacteria has been killed. The test is a “deep nasal” swab, and worth doing if there is lots of pertussis in the community or if the cough has been going on for many weeks.
But, after the paroxysmal phase begins, the chances of getting a good culture diminish. By the time the convalescent phase starts, you really can’t culture.
I’ve been doing a good bit of re-aquainting myself with the details of pertussis, because my husband has it now. The cough is so bad, he loses consciousness for a few seconds. He already has a knot on his head from hitting the fireplace. I can’t let him drive… He’s been on Erythromycin for 2 days, so he thinks he’ll be going back to work on Monday. :dubious: I don’t think so…
As someone who comes from a family plagued with asthma and allergies, let me reassure that such a diagnosis, should it happen, is not the end of the world.
The most important thing about these inflammatory airway problems is to get them under control and keep them under control. I’ve run into some parents who were afraid to have their children on steroids or inhalers or even anti-histamines for fear of side-effects and what-not. Well, yes, they are medications and used improperly can cause problems, but they are also wonderful things that can really make life better when used properly.
My understanding (and I’m sure the docs will correct me if I’m wrong) is that you need to remove the triggers for these problems whenever possible (it’s not always possible), then reduce the inflammation. Some folks need to take medicine prophyllactically during upper respiratory infections. Some need daily medication. Others don’t.
I won’t say my “reactive airways” never interfere with my life, but it is extremely rare that they do so. I have a niece with severe asthma, but it hasn’t stopped her from participating in sports, dance, and playing wind instruments. The key is keeping up with her daily schedule of medications and dealing with any flare ups early, before they become catastrophes. Most days, you’d never realize she has asthma and I only wish I had as much energy as she does.
Thanks, Broomstick, that’s really good to hear. And don’t worry, we are pretty pro-active about getting him treated for whatever it is causing the problem. I’d rather manage the medications and figure out the proper dosage etc., than try to manage my son who can’t sleep at night due to coughing.
picunurse and Dr_Paprika: They did not do a culture for pertussis to my knowledge, but Whatsit Jr. has had the full series of immunizations against it, for what that’s worth. He was not treated with ribavirin for the RSV either. Most of his treatments were to fight the bacterial pneumonia; he initially received some methicillin variant, but then when it turned out to be MRSA, he got vancomycin and rifampin instead. Apart from a diuretic in his first week at the hospital, and morphine to let him accept the ventilator and chest tubes, I don’t think he got any other meds at that time.
I’m sure you’re right picunurse. I probably don’t do as many cultures as I should for Bordatella. They can be pretty unpleasant for the child, and unless looking for early cases I might just be inclined to treat for CAP with erythromycin to cover the waterfront. Obviously, much depends on the sickness level of the child and what else I have seen in our small community emerg that week.
Very true. I don’t think its as much of a problem in small rural communities, unless a lot of the natives travel a lot. The might bring it home from a larger city.
I do believe the culture was designed by someone who hates children. I thought he was doing a transphenoidal hypophysectomy.
Keep current, I suspect it will reach you, eventually.
Meanwhile, I’m acting like a frightened swamp child when Hubby coughs. Tell me if I should be as worried as I am.
He begins to cough, paroxysmally, unable to inhale between coughs. His face turns red then purple. His eyes dilate and turn up and to the right. By this point he is unresponsive, still not breathing. If he were alone, he would have fallen on the floor. Then he postures, similar to decorticate and decerebrate posturing. He has, during different episodes pulled his arms in and up or down and away.
Finally, he seems to be able to take a “sip” of air and comes back to baseline very quickly.
The whole episode takes 30-45 seconds. Most times he is aware that he started to cough, but doesn’t remember anything else. A couple times, though, he said he could hear me telling him to breathe. He describes that as a “dream.”
Sorry, I guess I just needed to write it down so I could see just how serious it is.
I have to go to bed now.
Update: Whatsit Jr.'s pediatrician told us that essentially his chest X-ray came back looking like a kid who has asthma, but that they won’t make a diagnosis of asthma until he’s had at least two separate wheezing episodes, and I believe until he’s at least 6 years old, so in the meantime he gets “Reactive Airway Disorder.” The impression I got from her is that this is a term cooked up to avoid scaring parents by saying “asthma-like symptoms.”
Whatsit Jr. is now on a 3x/day albuterol treatment, and his cough is sounding a lot more productive and he’s looking a lot perkier. So really it could have been a lot worse. I am just kind of relieved it wasn’t anything more serious. The doc told us to keep up with the albuterol until the cough goes away, and then do it on an ad hoc basis as needed, which might be occasional, frequent, or never. (If frequent, she said we might need to look at some preventative treatments, i.e. steroids.)
Anyway, it looks like Whatsit Jr. is going to be fine, and the rest of us are all breathing a little easier too.
I presume he’s inhaling the albuterol? (Though with a kid that young I’d guess they’d have you use a nebulizer…) If so, try to get him to drink a full 8 oz of liquid after a breathing treatment. This will help prevent throat irritation. (Voice of Experience talking)
